Healthcare Provider Details

I. General information

NPI: 1982159778
Provider Name (Legal Business Name): BEDFORD VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2000
  • Fax:
Mailing address:
  • Phone: 781-687-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number0810005388
License Number StateVA

VIII. Authorized Official

Name: DR. CHARLES DREBING
Title or Position: CHIEF OF THE MENTAL HEALTH SERVICE
Credential: PHD
Phone: 781-687-2462